Hopson: Long term NHS plan must not be 'written behind the bike sheds'

The NHS long term plan must not be “written behind the bike sheds” by national chiefs if the NHS is to take ownership and deliver its targets, the body representing trusts has warned.

Chris Hopson, chief executive of NHS Providers, told HSJ trusts are not clear on how they will be consulted once the 10 workstreams feeding into the plan are completed – which is “the absolutely key question”.

Speaking to HSJ ahead of the NHS Providers conference, which starts in Manchester today, Mr Hopson also said:

There is a “nervousness” among trust leaders that the level of efficiency savings required in the plan will be “too high” and used as a “balancing item”;

Regulators should not publish action plans for trusts setting out how they must deliver savings – to do so is a “big mistake”; and

Responsibilities for workforce issues are “hopelessly fragmented” and the NHS needs to consider giving clinical permission for certain tasks carried out by doctors and nurses to be done by other staff groups.

His comments come a month ahead of the expected publication of the long term plan, which is being drawn up alongside the government pledge to give the NHS an extra £20.5bn over the next five years.

Ten workstreams, including efficiency and productivity, workforce, and primary care, have been set up to develop initial proposals. They are led by system leaders and four trust chief executives.

Mr Hopson said he was waiting to see how NHS England and NHS Improvement chiefs Simon Stevens and Ian Dalton respectively would consult frontline staff when drawing up the final plan.

“The six million dollar question is what happens when those workstreams come together,” he said.

“It’s great to have input through the workstreams via the chief executives, but if Simon and Ian take all that output behind the bike shed and write the plan without talking to anyone it would not create the sense of ownership and engagement needed.

“I do think there’s a slight danger in putting those CEOs in a difficult situation. Some very tough and difficult choices have to be made, and if NHSI and NHSE say the CEOs signed up to the plan but the rest of the NHS disagrees then those CEOs will be in an awkward position.

“The degree of consultation they have and the people they involve will be a key determinate in if the plan is supported or not.”

Mr Hopson also said the plan must come with a realistic efficiency plan, warning the Five Year Forward View set an unachievable £22bn savings target.

“System leaders have thought up to now that if you set a stretching target and push very hard then you get higher levels of efficiency – what we’re saying back is that may have worked a bit but is absolutely no longer working,” Mr Hopson said.

“You don’t get there by setting an over-ambitious target and saying ‘thou shalt thou shalt’. There has been an element of that in the past.”

He cited work on reducing agency staff expenditure as an area where trusts and the centre had successfully worked together to deliver savings.

But he added an example of the opposite, provided in feedback from trusts, was NHS Improvement’s operational productivity team, which has “tried to draw up action plans for trusts with figures and dates in it, and then saying ‘here’s your action plan, go and do it’.”

“The worst way to try to get trusts to take ownership is getting someone to do their action plan for them,” Mr Hopson said.

He stressed the trust sector is “not saying it can’t deliver more efficiencies”, but that trusts need to agree the “broad areas where efficiencies can be made” with NHS Improvement.

“We’re nervous that, because politicians and system leaders will be desperate to show this new money will buy lots of exciting things, people will try and make efficiency the balancing item, and they’ll set too high savings levels,” Mr Hopson added.

In his speech today, Mr Hopson is expected to call for workforce issues to become the responsibility of “one organisation”, after describing the current system as “hopelessly fragmented”.

“You’ve got the secretary of state and his team negotiating pay and conditions, NHSI are working on the agency cap and staff retention, Health Education England are doing future workforce planning and allocation of training budgets, the General Medical Council and Nursing and Midwifery Council deciding thresholds for registration and who can practice, and NHS Employers trying to provide advice to employers about these issues,” Mr Hopson said.

“The structure we’ve got is so hopelessly fragmented with people pulling in different directions and decisions made in silos. Who is responsible for the NHS workforce? The mere fact you can ask that question suggests there’s a fundamental problem.”

He will also call for regulators and professional bodies to explore allowing staff such as nursing associates and physician associates to perform tasks such as prescribing certain drugs that are currently only performed by doctors and nurses.

“If we could come together and agree on a careful risk assessed basis, we could start to fill some workforce gaps,” Mr Hopson said.

National bodies and government need to to support NHS leaders and staff to make changes to local relationships, to bring about integration in the interest of their communities, and create the right legislative and regulatory framework for local leaders and their organisations to succeed. By Niall Dickson